GRAND TETON CHILD NEUROLOGY (NPI# 1639322258) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1639322258 |
| Entity Type | Organization |
| Organization Name | GRAND TETON CHILD NEUROLOGY |
| Practice Address |
1975 Martha Ave Idaho Falls ID 83404-7580 |
| Practice Telephone | 2085294300 |
| Practice Fax Number | 2085291627 |
| Mailing Telephone | 2085294300 |
| Mailing Fax Number | 2085291627 |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2008-10-28 |
| Authorized Official Name | DR. PETER W CASTELLANOS (NEUROLOGIST) |
| Authorized Official Telephone | 2085294300 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| ID | BLUE CROSS OF IDAHO | 77234 | 01 |
| ID | 807968700 | 05 |
| Street Address |
1975 MARTHA AVE |
| City | IDAHO FALLS |
| State | ID |
| Zip Code | 83404-7580 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558457572 | Stephen R Marano | Neurological Surgery | 1975 Martha Ave, Ste A, Idaho Falls, ID 83404-7580 | 2006-10-05 |
| 1669785192 | Wind River Pain Management Pllc | Anesthesiology | 1975 Martha Ave, Suite B, Idaho Falls, ID 83404-7580 | 2010-07-26 |
| 1285959908 | Idaho Psychiatric Institute | Occupational Therapist | 1975 Martha Ave, Idaho Falls, ID 83404-7580 | 2010-04-06 |
| 1811211527 | Missy Renee Sturk | Occupational Therapist | 1975 Martha Ave, Idaho Falls, ID 83404-7580 | 2010-03-24 |
| 1881823979 | Brandon M Buhler | Marriage & Family Therapist | 1975 Martha Ave, Idaho Falls, ID 83404-7580 | 2009-07-09 |
| 1518110972 | Jessica C. Carlson | Counselor | 1975 Martha Ave, Idaho Falls, ID 83404-7580 | 2008-10-29 |
| 1568540706 | Steven V Klippert | Anesthesiology | 1975 Martha Ave, Ste. B, Idaho Falls, ID 83404-7580 | 2006-11-02 |
| 1497838478 | James Lee Cook | Neurological Surgery | 1975 Martha Ave, Ste A, Idaho Falls, ID 83404-7580 | 2006-10-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437750809 | Joshua M Murphy | Dentist | 1580 Elk Creek Dr., Idaho Falls, ID 83404 | 2020-11-03 |
| 1427618958 | Eastern Idaho Endodontics | Dentist | 3335 S. Holmes Ave, Idaho Falls, ID 83404 | 2019-06-17 |
| 1942863600 | Muhammad Arslan Khan | Student in an Organized Health Care Education/Training Program | 2860 Channing Way Suite 214, Idaho Falls, ID 83404 | 2019-04-18 |
| 1942771043 | Physician's Choice Cardiology, Pllc | Internal Medicine | 3302 Valencia, Suite 201, Idaho Falls, ID 83404 | 2018-12-16 |
| 1609358761 | Cardiac Cath Lab of Idaho Falls | Internal Medicine | 3311 Valencia Drive, Idaho Falls, ID 83404 | 2018-09-05 |
| 1083196380 | Hannah Golden | Occupational Therapist | 1460 Elk Creek, Idaho Falls, ID 83404 | 2018-09-04 |
| 1316423049 | Lindsay Sessions | Speech-Language Pathologist | 2210 Niagara St, Idaho Falls, ID 83404 | 2018-07-16 |
| 1720574023 | Bmh, Inc. | Anesthesiology | 3302 Valencia Dr., Suite 201, Idaho Falls, ID 83404 | 2018-07-10 |
| 1093237935 | Jason Earl Bailey | Contractor | 3100 S Woodruff Ave., Idaho Falls, ID 83404 | 2017-07-12 |
| 1235682121 | Mountain Falls Quick Care | Clinic/Center | 1995 E 17th St #1, Idaho Falls, ID 83404 | 2016-07-27 |
| Find all providers in zip 83404 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023634672 | Padron Counseling Services, LLC | Community/Behavioral Health | 522 Lomax St, Idaho Falls, ID 83401-2634 | 2020-06-19 |
| 1841830908 | Badger Inc | Community/Behavioral Health | 1650 N Holmes Ave, Idaho Falls, ID 83401-3200 | 2020-01-07 |
| 1275065807 | Jjst Enterprises Corp | Community/Behavioral Health | 1920 E 17th St Ste 213, Idaho Falls, ID 83404-8036 | 2017-04-02 |
| 1689068454 | Addiction Treatment Centers of Idaho | Community/Behavioral Health | 211 S. Woodruff Avenue, Idaho Falls, ID 83401 | 2015-03-19 |
| 1851706626 | Snake River Community Supported Living | Community/Behavioral Health | 557 S Woodruff Ave, Idaho Falls, ID 83401-5200 | 2014-06-30 |
| 1134556970 | Eastern Idaho Community Action Partnership | Community/Behavioral Health | 935 E Lincoln Rd, Idaho Falls, ID 83401-2119 | 2013-10-10 |
| 1750727459 | D7 Treatment | Community/Behavioral Health | 254 E St Ste B, Idaho Falls, ID 83402-3527 | 2013-05-21 |
| 1669815726 | Proventures LLC | Community/Behavioral Health | 1422 E 17th St, Suite A, Idaho Falls, ID 83404-6285 | 2013-04-09 |
| 1740580026 | Vista Health Center, LLC | Community/Behavioral Health | 452 D St, Idaho Falls, ID 83402-3531 | 2010-11-02 |
| 1689846362 | The Idaho Children's Rehabilitation Center | Community/Behavioral Health | 1975 Martha Avenue, Idaho Falls, ID 83404-7533 | 2008-04-02 |
| Find all providers in IDAHO FALLS | ||||
| City | IDAHO FALLS |
| Zip Code | 83404 |
Please comment or provide details below to improve the information on GRAND TETON CHILD NEUROLOGY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.